Fear and Loathing, Biopsy vs. Fibro scan in NZ

Ultrasound replaces painful liver biopsy surgery for hepatitis C patents in Auckland and Waikato

Painful biopsies have been replaced by an ultrasound technique the Fibroscan (a $200,000 machine) which provides a painless, non-invasive alternative to a needle biopsy by measuring the liver with ultrasound waves and evaluating progression of the disease.

“Obtaining liver tissue by a needle biopsy can be a very painful procedure resulting in bleeding, perforation of other organs, even hospital admission and, rarely, death,” Dr Weilert said.

“This has previously been the only option to assess the liver but the Fibroscan allows us to measure liver stiffness without invasive action.

“It will also allow us to map progress of liver disease better.”

The Fibroscan works through a probe held against the patients’ abdomen.

“The Fibroscan generates a pulse which sends waves through the liver, measuring its stiffness. The degree of stiffness in the liver indicates the amount of disease in the liver – so the greater the stiffness, the more disease there is”, adds Professor Gane.

“Because the Fibroscan procedure is so quick and easy we are able to see more patients in a shorter amount of time and patients no longer need to wait for months to start their antiviral therapy

The procedure takes about 15 minutes. There are currently machines in Auckland and Waikato

See below for Deliverable Three Undertake an analysis and develop a report on the utilisation of fibro scanning in New Zealand:

http://www.waikatodhb.govt.nz/news/pageid/2145843080
http://www.stuff.co.nz/waikato-times/news/1402330

Associate Professor Ed Gane Champion for HCV for the Ministry of Health.

Associate Professor Gane this year was appointed as Champion for HCV for the Ministry of Health.

In September 2005 a commitment was made by the government, to resolve the longstanding concerns of those infected with hepatitis C through the blood supply. Within this commitment a variety of measures were promised, including provision of an enhanced treatment package. Additional funding was sought and secured for this treatment package and a Hepatitis C Treatment Advisory group, comprising of clinicians, DHB managers and community representatives and chaired by Ed Gane was established to advise the Ministry of Health.

The terms of reference of the Hepatitis C Treatment Advisory Group were to develop a costed and prioritised Implementation Plan, supported by district health boards (DHBs) and the Ministry of Health. This group first met on 17 April 2007. During 2008, they conducted a comprehensive Stocktake of current HCV treatment services provided at each of the 21 DHBs. Following analysis of these results and other information, the committee identified barriers to accessing this treatment and geographical gaps in service provision. They identified priority interventions to improve services and patient outcomes throughout NZ and developed a costed and prioritised implementation plan for improving the access to and uptake of Hepatitis C treatment in New Zealand. The subsequent Health Report and the Hepatitis C Plan was submitted to Hon. Tony Ryall by HCTAG in January 2009.

On 28 July 2009, the Minister approved the “Strategic Directions for Hepatitis C – improving access to and uptake of hepatitis C treatment services” and signed off the funding allocation to address the key action areas within the document. These four key action areas, identified within Strategic Directions for Hepatitis C, are: (i) improving HCV treatment services;(ii) improving knowledge of HCV among primary health care providers; (iii) increasing the percentage of all people with HCV who have had the disease diagnosed; (iv) improving the knowledge of HCV prevalence in the New Zealand population and within subgroups.

Plans for primary care, including the new e-learning tool for GPs and Practice Nurses, designed to improve knowledge and encourage opportunistic screening for HCV.

Four Million Dollars Missing from New Zealand Hepatitis C Program

“A major component of the $30 million package announced in December last year is an additional $5 million per year to be invested to improve access to, and uptake of, hepatitis C treatment services. An advisory group has been established to assist the Ministry of Health and District Health boards improve hepatitis C treatment services to all people with hepatitis C, who are entitled to publicly funded health services.”
The ministry have now budgeted one million dollars for these service improvements wonder where the other four million promised went ?

So thirty million to pay for the New Zealand Ministry of health’s professionally incompetent advice and poor performance in protecting the blood supply.

Just one million of a promised five million to improve the situation and actually treat people

Four million dollars just disappearing I get the feeling this is another colossal ministry cost cutting mistake in the making how expensive is this poor health policy going to be in the long term ? time will tell.

Note : To get our (www.hcv.org.nz) copy of the Strategic Directions document we had to write many  Official Information act requests. The Ministry of Health who subsequently lied about our requests to the ombudsman (and were stupid enough to get caught lying) had withheld it for over a year. Now where do you think the Ministry tell people to go to get a copy of the “Strategic Directions for Hepatitis C – improving access to and uptake of hepatitis C treatment services”  Well here to  peer based organisation that has no funding www.hcv.org.nz we are hosting Strategic Directions for Hepatitis C document and the only place it’s available, their key document for a million dollar tender W.T.F.

What the ministry want to buy for one million dollars to improve access to and uptake of hepatitis C treatment services

The Ministry is seeking a Provider to deliver the following services for individuals with Hepatitis C:

• appropriate referral from primary care to secondary care via use of a standardised tool;
• provision of integrated care for those diagnosed but untreated or discharged following treatment via use of a shared care clinical tool / protocol;
• equitable access to fibro scanning for diagnosis;
• improved information resources for specific ‘at risk’ population groups; and
• improved detection, access and treatment service delivery models.

The following services are being purchased:

Deliverable One
Develop, consult and disseminate nationally into primary care a standardised referral tool / form from primary to specialist care.
Deliverable Two
Develop, consult and disseminate nationally across providers, a shared care clinical tool / protocol, for the provision of integrated care / management for:
Deliverable Three
Undertake an analysis and develop a report on the utilisation of fibro scanning in New Zealand including:
Deliverable Four
Develop, consult and disseminate nationally education / information resources for specific sub-population ‘risk’ groups including:

Development of a plan for targeted testing will enable implementation of more effective detection and treatment of at risk groups.
Deliverable Five
Research and provide a feasibility report for a potential three-year programme to promote
the targeted testing of specific ‘at risk’ groups to improve early HCV diagnosis rates and
treatment options for these individuals.
Deliverable Six
Undertake research and development of innovative HCV service delivery model(s) for New Zealand:

(If you want a copy of full tender document you have to go to NZ government GETS site and register )

So if you want a slice of the pie get your applications in It looks like a bunch of stakeholders have tried to carve up the funding pie in to neat little segments only time will tell how effective this will be.

Epidemiological ongoing measurement of the spread of Hepatitis C actually gets a special mention in Strategic directions document but seems to have been completely ignored in the proposal for services. I just wonder where the evidence base for this spending is coming from if we don’t accurately count the epidemic on a ongoing basis?

I would like to have seen money spent on measuring the epidemic more accurately, although as there seems to be an emphasis on meshing the diagnosis / treatment and care of hepatitis C in to a new national GP information system, may be this will also count the spread of the epidemic ?

Looks like we are going to get more community clinics (Deliverable Six) because we need to duplicate treatment services, New Zealand being awash in spare health funding we can afford this ? Most of the country has no access to support services. Wellington Waikato and Invercargill no resources no support services with rural NZ getting the big nothing.This inequality of access to support needs to be addressed on a national basis rather a than a few regions.

We are farming the newly infected from ineffective  needle exchange programs that grow the epidemic , on to community clinics at needle exchanges delivering treatment, a win win situation for needle exchanges as far as capturing  health resources.

This development of a duplicate service to serve the needs of IDU (intravenous drug users) would be better addressed by educating health professionals on how to best to care for and not stigmatize IDU using existing resources  rather than developing a expensive  duplication of resources.

Well the next six months should reveal the shape of hepatitis C improvements so I guess that is progress and I should be a bit more positive about it. Fingers crossed something good happens.

Stop people dying needlessly

My favourite way of testing and diagnosing the majority of individuals who are no longer if ever active drug users would be the English system of pharmacy testing which has proved much more successful that GP based testing.
Last year a viral hepatitis testing pilot project in 19 pharmacies across the country has found a hepatitis B or C positive patient in every 6 tests conducted. Across the pharmacies a total of 234 tests were conducted, diagnosing 35 people with hepatitis C (15% of tests) and 4 people with hepatitis B (2% of tests). This is a far higher proportion of hepatitis C positive diagnoses than found in GP surgeries, where 4% of tests find positive hepatitis C patients and 2% of tests find hepatitis B patients.

Charles Gore, Chief Executive of The Hepatitis C Trust said: “It is a tragedy that increasing numbers of people with hepatitis B and C are dying, often from particularly unpleasant liver cancer which these viruses can cause. It is a tragedy because they have generally been living with the virus for years and could have been given treatment at any point, if only they had been diagnosed. So we desperately need new approaches to testing that will find the undiagnosed patients and this pilot study shows pharmacy testing could be just what is needed.”

“If the pharmacy testing pilot is taken as a model and rolled out by PCTs and pharmacies nationally, we can stop people dying needlessly.”

The Isle of Wight continues to offer these tests after the end of the pilot scheme and has extended it to include added HIV and syphilis tests from the same sample as the viral hepatitis screen. When asked, Gary Warner from Regent Pharmacy on the Island said:

“The results speak for themselves - pharmacies see a different cohort of people to those who see their GP and therefore we can access and diagnose people who otherwise would not have been tested. As an example, the patient that was screened as HIV positive was not someone who would have accessed the test in any other way.”

http://www.medicalnewstoday.com/articles/198364.php

press video here

http://www.youtube.com/watch?v=iG49NTOvOEU

best of health

www.hcv.org.nz